scholarly journals Incidence and Factors that Affect Anterior Sacral Foramen Leakage in Fluoroscopically Guided Caudal Epidural Steroid Injection

2021 ◽  
Vol 9 (1) ◽  
pp. 1-5
Author(s):  
Chan Hong Park ◽  
◽  
Hyen Jun Kim ◽  
Sang Ho Lee
Keyword(s):  
Intervertebral Disc ◽  
Steroid Injection ◽  
Epidural Steroid Injection ◽  
Epidural Needle ◽  
Needle Position ◽  
Sacral Hiatus ◽  
Tip Position ◽  
Sacral Canal ◽  
Epidural Steroid ◽  
Caudal Epidural

Background: During the caudal epidural steroid injection (CESI), sacral foramen leakage can occur. The aim of this study was to evaluate incidence and the correlation of anterior sacral foramen leakage with several factors. Methods: We retrospectively analyzed the medical records of patients who underwent CESI. The epidural needle position and sacral foramen leakage (yes or no) in C-arm view were recorded. The following parameters were measured: 1) depth of the intervertebral disc at S1-S2, S2-S3, and S3-S4; 2) distances between the posterior borders of S1 and the apex of the sacral hiatus; and 3) depths of S1, S2 the sacral canal. Results: Ninety-one subjects were evaluated. The patients were predominately women (60%) with a mean age of 65.5 ± 11.6 years. There was leakage in 58% (53/91) of patients. One-level leakage occurred in the largest proportion of patients (27%). Age, gender, needle tip position, the depth of the intervertebral disc at S1-S2, S2-S3, and S3-S4, the distances between the posterior borders of S1 and the apex of the sacral hiatus, and the depths of S1, S2 the sacral canal were not correlated with sacral foramen leakage. Conclusion: We found leakage in 58% of patients regardless of age, gender, needle-tip position, the depth of the intervertebral disc at S1-S2, S2-S3, and S3- S4, the distances between the posterior borders of S1 and the apex of the sacral hiatus, and the depths of S1, S2 the sacral canal. Therefore, clinicians should be aware that leakage can occur in any circumstance. Keywords: incidence, factors, anterior, sacral, foramen, leakage, fluoroscopically, caudal, epidural, steroid, injection.

Caudal Epidural Steroid Injection: Ultrasound

2016 ◽  
Author(s):  
Imanuel R. Lerman
Keyword(s):  
Ultrasound Guidance ◽  
Steroid Injection ◽  
Imaging Technique ◽  
Imaging Modality ◽  
Needle Insertion ◽  
Epidural Steroid Injection ◽  
Fluoroscopic Guidance ◽  
Sacral Hiatus ◽  
Epidural Steroid ◽  
Caudal Epidural

Ultrasound guidance can facilitate caudal epidural steroid injection by providing a clear view of the sacrum, the sacral hiatus, and the needle as it is advanced through the sacrococcygeal ligament into the sacral hiatus. Using ultrasound guidance for the initial needle insertion can eliminate the exposure of the physician and patient to ionizing radiation. However, the use of ultrasound guidance as a sole imaging technique for caudal epidural steroid injection does have disadvantages. Contrast fluoroscopic guidance is necessary to visualize the needle once it passes under the apex of the sacral hiatus to confirm that the needle tip is extradural and indeed extravascular. The use of ultrasound and fluoroscopic guidance takes advantage of each imaging modality to enhance the safety and accuracy of the caudal epidural steroid injection.

Caudal Epidural Steroid Injection: Fluoroscopy

2016 ◽  
Author(s):  
Imanuel R. Lerman ◽  
David Hiller ◽  
Joseph Walker
Keyword(s):  
Steroid Injection ◽  
Imaging Modality ◽  
Ultrasound Image ◽  
Epidural Steroid Injection ◽  
Fluoroscopic Guidance ◽  
Routine Procedure ◽  
Contrast Enhanced ◽  
Sacral Hiatus ◽  
Epidural Steroid ◽  
Caudal Epidural

The caudal epidural steroid injection can be a routine procedure. However, the underlying anatomy of the sacral hiatus is highly variable and can be difficult to visualize under fluoroscopy. The “blind” palpation technique has repeatedly been shown to be inferior, resulting in significantly more complications, when compared to employing contrast-enhanced fluoroscopic guidance. Ultrasound image guidance can accurately localize the sacral hiatus more consistently than the palpation technique. However, ultrasound guidance does not improve the accuracy of proper needle placement, as ultrasound cannot visualize the needle or injectate after the needle has passed under the apex of the sacral hiatus. Fluoroscopic guidance is necessary to visualize the needle and to confirm that the needle tip is extradural, extravascular, and in the epidural space, and it is likely to remain the gold standard imaging modality when carrying out caudal epidural steroid injection.

scholarly journals Effect of Caudal Epidural Steroid Injection in Chronic Low Back Pain due to Prolapse Intervertebral Disc

2015 ◽  
Vol 26 (2) ◽  
pp. 49-52
Author(s):  
R Sharma ◽  
SY Kothari ◽  
BB Thukral ◽  
S Chaudhary
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Intervertebral Disc ◽  
Rating Scale ◽  
Steroid Injection ◽  
Epidural Steroid Injection ◽  
Low Back ◽  
Epidural Steroid ◽  
Caudal Epidural

Abstract Background Low back pain (LBP) due to disc herniation is a frequent cause of back pain. It is a debilitating condition having enormous medical and socio-economic effects. Epidural injection of steroids has been used to treat LBP for many decades. Despite widespread use and numerous publications there is significant controversy with regards to the medical necessity and indications for epidural injections, hence we planned this study. Materials and methods This was a prospective follow-up study. Forty-one patients of confirmed diagnosis of prolapse intervertebral disc (PIVD) were included. Caudal epidural steroid injection (CESI) of 80 mg methylprednisolone acetate diluted in 20 ml of 0.9% saline was given. Outcome was assessed by Numeric Pain Rating Scale (NRS), Oswestry Disability Index (ODI), Straight Leg Raise (SLR) and Modified Schober Test (MST) at baseline, one, three, six and twelve weeks follow-up. Results Thirty-seven patients completed the study. Significant improvement in patient's status was observed after CESI, as measured with MST, SLR, NRS and ODI at one and three weeks post injection and the improvement were maintained till 12th week. Eighty-three per cent of patients were satisfied at the end of the study and side-effects reported were mild. Conclusion CESI is a simple, safe and cost effective intervention procedure for the treatment of chronic LBP due to PIVD. It provides rapid pain relief and improvement of physical function starting within a week of injection.

scholarly journals Caudal epidural steroid injection ultrasound-guided versus fluoroscopy-guided in treatment of refractory lumbar disc prolapse with radiculopathy

2020 ◽  
Vol 51 (1) ◽  
Author(s):  
Mohamed Ahmed Elashmawy ◽  
Reham M. Shaat ◽  
A. M. Abdelkhalek ◽  
Ebrahim El Boghdady
Keyword(s):  
Steroid Injection ◽  
Lumbar Disc ◽  
Epidural Steroid Injection ◽  
Successful Outcome ◽  
Post Injection ◽  
Disc Prolapse ◽  
Lumbar Disc Prolapse ◽  
Straight Leg Raising ◽  
Epidural Steroid ◽  
Caudal Epidural

Abstract Background Lumbar disc prolapse is a localized herniation of disc beyond intervertebral disc space and is the most common cause of sciatica; the aim of this study is to investigate the efficacy of ultrasound (US)-guided caudal epidural steroid injection (CESI) compared with fluoroscopy (FL)-guided CESI in treatment of patients with refractory lumbar disc prolapse (LDP) with radiculopathy. Results At the beginning of the study, there was no significant difference between both groups in all parameters. (a) Group 1 had significantly improved the straight leg raising and modified Schober tests, VAS, and ODI at 1-month and 3-month post-injection evaluation in comparison to baseline recordings (p < 0.001); (b) Group 2 had significantly improved the straight leg raising and modified Schober tests, VAS, and ODI at 1-month and 3-month post-injection evaluation in comparison to baseline recordings (p < 0.001); and (c) US-guided CESI was not statistically different from the FL-guided CESI in the improvement of the straight leg raising (p = 0.87, 0.82) and modified Schober tests (p = 0.87, 0.82) as well as VAS (p = 0.40, 0.43) and ODI (p = 0.7, 0.2) at 1-month and 3-month post-injection evaluation. In a multivariate analysis using CI = 95%, the significant predictors for a successful outcome were duration < 6 months (p = 0.03, OR = 2.25), target level not L2-3/L3-4 (p < 0.001, OR = 4.13), and LDP other than foraminal type (p = 0.002, OR = 3.78). However, age < 40 years was found to be non-significant in predicting a successful outcome (p = 0.38, OR = 0.98). Conclusion US is excellent in guiding CESI with similar treatment outcomes as compared with FL-guided CESI. Trial registration ClinicalTrials.gov Identifier: NCT03933150.

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